Hospitalization Summary Reports Research Articles

A Cross-Sectional Study of Breast Cancer Surgery and the Cost Based on Data From 77 Chinese 3A Hospitals in 2015.

PurposesWe aimed to clarify the real-world status of breast cancer surgery and the cost in China.MethodsThis cross-sectional survey relied on data obtained from the hospitalization summary reports (HSRs) in 77 top-ranked (grade 3A) hospitals in China to analyze breast cancer patients who underwent surgery between January 2015 and December 2015. The surgery and cost were mainly evaluated.ResultsOverall, 31,900 breast cancer patients underwent surgeries in 77 hospitals. The mean age in our study was 51.5 years (SD, 11.7 years). The primary types of surgical procedures were mastectomy (n = 24,629, 77.2%) and breast-conserving surgery (6,210, 19.5%). The rate of mastectomy was the highest at age band 50–65 years (n = 10,861, 82.1%) and in non-first-tier cities (n = 7,651, 88.4%) as well as in Northeast China (n = 3,107, 93.2%). The rate of breast-conserving surgery was less than 10% in non-first-tier cities (9.8%), Southwest China (6.1%), and Northeast China (5.8%). The median cost was $3,352.4 (interquartile range (IQR), $2,492.6–4,588.0). Mastectomy cost was significantly higher than breast-conserving surgery cost in both different city tiers and regional distribution except Northeast China (p < 0.001).ConclusionsThis study demonstrated that the main breast cancer surgery in Chinese 3A hospitals was mastectomy and that the cost varied both across and within geographic regions and city tiers. This information helps describe the real-world status of breast surgery and the cost in China.

Features of colorectal cancer in China stratified by anatomic sites: A hospital-based study conducted in university-affiliated hospitals from 2014 to 2018.

ObjectiveThe clinical and biological characteristics of colorectal cancer have been found to differ depending on the anatomic site of the cancer. However, for Chinese patients, there is limited information on the proportion of cases at each site and the related features. In this study, we explored the location, distribution and other features of colorectal cancers at each anatomic site in Chinese patients.MethodsWe conducted a hospital-based study using hospitalization summary reports from 10 Peking University-affiliated hospitals from 2014 to 2018; the reports covered a total of 2,097,347 hospitalizations. Incident cases were chosen as the study population, and their epidemiological features were further analyzed.ResultsA total of 20,739 colorectal cancer patients were identified. Rectum was the most common location (48.3%) of the cancer, whereas the proportions of patients with distal and proximal colon cancer were 24.5% and 18.6%, respectively. Patients with rectal cancer were predominantly male and were the youngest for all anatomical sites (each P<0.001). The highest proportion of emergency admissions, the longest hospital stays and the highest hospitalization costs were found in patients with proximal colon cancer (each P<0.001). The proximal colon cancer subgroup included the highest proportions of patients with medical histories of cholecystectomy, cholecystolithiasis and/or gallbladder polyps and appendectomy (P=0.009, P<0.001 and P<0.001, respectively). The distal colon cancer subgroup included the highest proportions of patients with medical histories of diabetes and hypertension (P<0.001, respectively).ConclusionsThe patterns of colorectal cancer observed in this study differ from those reported for Western patients and show a significantly higher proportion of patients with rectal cancer. Different epidemiological features were also found based on anatomic sites. Further studies based on tumor location should be conducted to facilitate more accurate screening and treatment.

Meteorological Influence on Tissue Expander-Related Major Infection

ABSTRACT Background Infection is a relevant complication of tissue expander surgery that may compromise the flap. The effects of meteorological variables on surgical site infection have been observed in many surgeries; however, their influence on tissue expander infection is unknown. Methods We identified tissue expander implantation and infection based on their International Classification of Diseases, 10th revision, codes in electronic hospitalization summary reports of 26 cities from January 1, 2014 to December 31, 2015. The data of the present study were collected for administrative purposes without any personal identifiers. The Cox proportional hazard model was used to investigate the association between meteorological variables and tissue expander-related major infection with six covariates. Results A total of 3,089 patients were enrolled. Of them, 8.7% experienced a major infection during the study period. The optimal daily average temperature was between 22.9 °C and 26.8 °C, and the risk of major infection was significantly decreased in this range. The minimal infection temperature was 24.4 °C, with a hazard ratio of 0.85. When the average relative humidity was 37%, the infection risk was minimal with a hazard ratio of 0.86; however, a relative humidity of ≥ 79% significantly increased the risk of infection. Conclusions This is the first study to investigate the impact of temperature and relative humidity on tissue expander-related major infection. Our study suggests that there may be an optimal range of both temperature (22.9 °C–26.8 °C) and relative humidity (

Association between ambient particulate matter and hospitalization for anxiety in China: A multicity case-crossover study.

Evidence concerning the impact of ambient particulate matter (PM) on mental health is just emerging and inconsistent. Air pollution with high PM levels has been frequently reported in China, however, no Chinese study has determined the association between PM exposures and anxiety hospitalizations. We examined the potential association between PM concentrations and anxiety admissions in 26 Chinese cities from January 2014 to December 2015. A time-stratified case-crossover design was employed in the study. Anxiety hospitalizations were identified according to ICD-10 from the electronic hospitalization summary reports system in China. Conditional logistic regression was applied to estimate the relation between PM levels and anxiety admissions, stratified by age and sex. Positive associations between PM2.5/PM10 and admitted anxiety cases were observed. PM2.5 had the largest effect estimate at lag 5 days, with a per 10 μg/m3 increase corresponding to a 0.63% (95% CI, 0.26-1.00) increase in anxiety admissions. PM10's largest effect estimate was observed at lag 3 days, increasing 0.37% (95% CI, 0.12-0.62) anxiety admissions per 10 μg/m3. Females were more sensitive to PM2.5/PM10 concentrations than males, however, the effect modification by age was not significant. A marginally significant distinction in anxiety hospitalizations was found in patients with and without CVDs when they were exposed to PM2.5. Our findings indicate that short-term exposure to increased concentrations of PM2.5/PM10 exacerbates risks of anxiety hospitalizations in 26 Chinese cities. We observed effect modification by sex, with significantly stronger associations in female patients. This study offers the promise that reducing PM air pollution could probably reduce the huge disease burden from anxiety disorders.

Acute effects of fine particulate matter (PM2.5) on hospital admissions for cardiovascular disease in Beijing, China: a time-series study

BackgroundAir pollution and cardiovascular disease are increasing problems in China. However, the short-term association between fine particulate matter (PM2.5) and cardiovascular disease (CVD) is not well documented. The purpose of this study is to estimate the short-term effects of PM2.5 on CVD admissions in Beijing, China.MethodsIn total, 460,938 electronic hospitalization summary reports for CVD between 2013 and 2017 were obtained. A generalized additive model using a quasi-Poisson distribution was used to investigate the association between exposure to PM2.5 and hospitalizations for total and cause-specific CVD, including coronary heart disease (CHD), atrial fibrillation (AF), and heart failure (HF) after controlling for the season, the day of the week, public holidays, and weather conditions. A stratified analysis was also conducted for age (18–64 and ≥ 65 years), sex and season.ResultsFor every 10 μg/m3 increase in the PM2.5 concentration from the previous day to the current (lag 0–1) there was a significant increase in total CVD admissions (0.30, 95% CI: 0.20, 0.39%), with a strong association for older adults (aged ≥65 years), CHD (0.34, 95% CI: 0.22 to 0.45%) and AF (0.29, 95% CI, 0.03 to 0.55%). However, the observed increased risk was not statistically significant for HF hospitalizations. The associations in the single-pollutant models were robust to the inclusion of other pollutants in a two-pollutant model. No differences were found after stratification by sex and season.ConclusionsExposure to PM2.5 increased the risk of hospitalizations from CVD, especially for CHD, and appeared to have more influence in the elderly. Precautions and protective measures and efforts to reduce exposure to PM2.5 should be strengthened, especially for the elderly.

Rare diseases in China: analysis of 2014\u20132015 hospitalization summary reports for 281 rare diseases from 96 tertiary hospitals

BackgroundThere are many public health issues to resolve regarding rare diseases, including a lack of data from large-scale studies. The objective of this study was to explore fundamental data for a list of rare diseases in China, based on a hospitalization summary reports (HSRs) database. The Target Rare Diseases List (TRDL) 2017 was generated using an expert consensus method in which experts listed diseases according to research priorities. Using codes of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and key search terms of rare diseases in English and Chinese, data were obtained from HSRs of 96 hospitals, covering a population of over 15 million in China from 2014 to 2015. We extracted and analyzed information on demographics, hospitalizations, and readmissions.ResultsA total 281 rare diseases were included in the TRDL 2017. Altogether, 106,746 hospitalizations for a rare disease were captured from 1 January 2014 to 31 December 2015, accounting for 0.69% of inpatients during the same period. The top 10 rare diseases with most cases on the TRDL 2017 were thalassemia, idiopathic pulmonary arterial hypertension, pulmonary Langerhans cell histiocytosis, moyamoya disease, motor neuron disease, idiopathic pulmonary fibrosis, systemic sclerosis, hepatolenticular degeneration, coarctation of the aorta, and transposition of the great arteries. Among the 24 cities in the database, the five cities with the most types of the rare disease were Beijing, Changsha, Guangzhou, Shanghai, and Chengdu, with 191, 162, 143, 141, and 133 types, respectively. The five cities with most cases of the 281 rare diseases were Beijing, Guangzhou, Shanghai, Nanning, and Chengdu. The age distribution of rare diseases was 52% for the age group 25–64 years, and 27% of cases in the age group of 0–14 years were among children. The 10 highest readmission rates ranged from 35 to 65%.ConclusionsThis study provided the TRDL 2017 and descriptive analysis of 281 rare diseases in a hospitalized population. Our study reveals important fundamental information that will be useful in national policy making and legislation; registry implementation; and diagnosis, treatment, and prevention of rare diseases in China.

Short-term effect of ambient sulfur dioxide (SO2) on cause-specific cardiovascular hospital admission in Beijing, China: A time series study

Evidence of the short-term effect of SO2 on hospital admissions for cause-specific cardiovascular diseases (CVD) is still limited. This study aimed to examine the short-term associations between SO2 and cause-specific CVD hospital admission in Beijing. A total of 460,938 hospitalizations for total CVD were obtained from electronic hospitalization summary reports from 2013 to 2017. A time series analysis was conducted to investigate the association between SO2 exposure and hospitalizations for total and cause-specific CVD, including coronary heart disease (CHD), atrial fibrillation (AF), and heart failure (HF). Stratified analysis was also conducted by age group (18–64 years and ≥65 years), sex and season. A generalized additive quasi-Poisson model was used to examine the associations between SO2 and cause-specific CVD after controlling for seasonality, day of the week, public holidays, and weather conditions. We found an almost linear relationship between the exposure to SO2 and cause-specific CVD admissions. A 10 μg/m3 increase in the two-day average concentration (lag0-1) of SO2 was associated with an increase of 1.38% (95% CI:0.99%; 1.77%) in hospital admission for total CVD, 1.58% (95% CI: 1.16%; 2%) for CHD and 1.69% (95% CI:0.41%; 2.99%) for AF. Nevertheless, a statistically significant association was not observed for admissions for HF. The observed associations in the single-pollutant models were robust to the inclusion of pollutants in the two-pollutant model, but the estimate was attenuated when adjusting for fine particulate matter (PM2.5). No difference in the association was observed for the effect modifiers of sex, season and age. A statistically significant association between hospitalizations and SO2 was observed. The observed association between SO2 and hospitalization might not be independent of fine particulate matter (PM2.5), and further studies should be conducted to demonstrate the independent effect of SO2.

Formulating a preoperative risk scoring system for elderly patients with hip fracture

Objective To establish a preoperative risk scoring system for elderly patients with hip fracture on the basis of investigation into the factors influencing their mortality during hospitalization. Methods The data were collected from the database of hospitalization summary reports (HSR) of Beijing Public Health Commission concerning the 14,577 patients who had been 55 years old or older and hospitalized for hip fracture from January 1, 2006 throughout December 31, 2010 at the 35 top-rank hospitals in Beijing. They were divided into a surgery group and a non-surgery group. Two multivariable risk-adjustment models were established for the 2 groups on the basis of an investigation into the factors influencing their mortality during hospitalization. Finally a preoperative risk scoring system for elderly patients with hip fracture was formulated according to the valuation of the least common multiples of β coefficients of the risk factors. Results Besides senior age and male gender, 10 different comorbidities were independently associated with in-hospital mortality, particularly pulmonary embolism, respiratory failure, renal failure and diabetes. The risk for inpatient mortality associated with a specific comorbidity was relatively higher in the surgery group than in the non-surgery group. The risk-adjustment models based on the variables had better accuracy in predicting in-hospital mortality (ROC=0.91 in surgery group versus ROC=0.85 in non-surgery group). In our preoperative risk scoring system for elderly patients with hip fracture, 10 points were for an age of 65 to 74 years old, 14 points for an age of 75 to 84 years old, 18 points for an age beyond 85 years old, 4 points for male gender, 20 points for pulmonary embolism, 18 points for respiratory failure, 10 points for renal insufficiency, 8 points for diabetes, 8 points for heart failure, 7 points for malignant tumor, 7 points for lung infection, 7 points for disturbance of water, electrolyte and acid-base balance, 6 points for arrhythmia, and 6 points for cerebral infarction, totaling 119 points. Conclusions The primary risk factors for in-hospital mortality in the elderly patients with hip fracture seem to be senior age, male gender and 10 different comorbidities. A preoperative risk scoring system has been successfully established for elderly patients with hip fracture. Key words: Hip; Fracture, bone; Aged; Comorbidities; Mortality

Effects of ambient carbon monoxide on daily hospitalizations for cardiovascular disease: a time-stratified case-crossover study of 460,938 cases in Beijing, China from 2013 to 2017

BackgroundEvidence focused on exposure to ambient carbon monoxide (CO) and the risk of hospitalizations for cardiovascular diseases (CVD) is lacking in developing countries. This study aimed to examine the effect of CO exposure on hospitalizations for CVD in Beijing, China.MethodsA total of 460,938 hospitalizations for cardiovascular diseases were obtained from electronic hospitalization summary reports from 2013 to 2017. A time-stratified case-crossover design was conducted to investigate the association between CO exposure and hospitalizations for total and cause-specific CVD, including coronary heart disease (CHD), atrial fibrillation (AF), and heart failure (HF). Stratified analysis was also conducted by age group (18–64 years and ≥ 65 years) and sex.ResultsLinear exposure-response curves for the association between ambient CO exposure and hospitalizations for CVD was observed. Ambient CO was positively associated with hospitalizations for total CVD and CHD. However, the observed increased risk was not statistically significant for hospitalizations for AF and HF. The strongest effect of CO concentration was observed on the current- and previous-day of exposure (lag 0–1 day). For a 1 mg/m3 increase in a 2-day moving average CO concentration, an increase of 2.8% [95% confidence interval (CI): 2.2 to 3.3%] and 3.0% (95% CI: 2.4 to 3.6%) in daily hospital admissions for CVD and CHD were estimated, respectively. This association was robust after adjusting for other copollutants and did not vary by age group and sex.ConclusionsAmbient CO exposure increased the risk of hospitalizations for CVD, especially for CHD in Beijing. Further studies are warranted to explore the association between ambient CO and hospitalizations for AF and HF.

The effect of ambient particle matters on hospital admissions for cardiac arrhythmia: a multi-city case-crossover study in China

BackgroundThe relationship between particle matters (PMs) and cardiac arrhythmia has been investigated in numerous studies. However, evidence from developing countries is limited. The aim of this study was to evaluate the association between ambient PMs and hospital admissions for cardiac arrhythmia in China and to examine the potential effect modifiers.MethodsA time-stratified case-crossover analysis was conducted in 26 large Chinese cities. In total, we identified 175,265 hospital admissions for cardiac arrhythmia between January 2014 and December 2015 from electronic hospitalization summary reports. Conditional logistic regression was performed to estimate the percentage changes in cardiac arrhythmia admissions in relation to interquartile range increases in air pollutants. Age, gender and prespecified comorbid health conditions including hypertension, diabetes, congestive heart failure and hyperlipidemia were stratified to evaluate susceptibility factors.ResultsPMs levels were positively associated with the number of hospital admissions for cardiac arrhythmia. Both PM2.5 and PM10 had the strongest impact on lag 2 days. An interquartile range increase in PM2.5 (47.5 μg/m3) and PM10 (76.9 μg/m3) concentrations on lag 2 days was associated with increments of 2.09% (95%CI, 1.58–2.60%) and 2.33% (95%CI, 1.68–2.97%) in hospital admission for cardiac arrhythmia, respectively. Evidence of effect modification by age and comorbid diabetes was observed. The elderly (> 65 years) and patients with comorbid diabetes were more likely to be hospitalized for cardiac arrhythmia following exposure to high levels of PMs.ConclusionsThis study found an increased risk of arrhythmia admissions associated with PM2.5 and PM10 levels among 26 Chinese cities. The associations of PMs with arrhythmia admissions were stronger in aged population and people with diabetes.

Association between ambient particulate matter concentrations and hospitalization for ischemic heart disease (I20-I25, ICD-10) in China: A multicity case-crossover study

BackgroundIschemic heart disease is a serious cause of death. Ambient particulate matter pollution is similarly defined a national environmental issue in China. The objective of this study was to examine the association of particulate matter with hospital admissions for ischemic heart disease in 26 large Chinese cities. MethodsThe study identified 720,261 hospital admissions for ischemic heart disease by using electronic hospitalization summary reports from 1 January 2014 through 31 December 2015. Conditional logistic regression was used to estimate the percent changes with 95% confidence intervals (CIs) in ischemic heart disease admissions in relation to an interquartile range increase in ambient particulate matter concentrations. We also assessed the effect modification of ischemic heart disease risk by geographical region, gender, and age. ResultsThe means of air pollutants were 63.5 ± 50.6 μg/m3 for PM2.5, 106.8 ± 71.9 μg/m3 for PM10. The levels of PM2.5 and PM10 concentrations in northern China were much higher than those in southern China. Both PM2.5 and PM10 had the strongest effect for daily ischemic heart disease admissions on lag 2 days, with an interquartile range (IQR) increase in PM2.5 (47.5 μg/m3) and PM10 (76.9 μg/m3) at lag 2 days corresponded to a 1.7% (95% CI, 1.5–1.9%) and 2.0% (95% CI, 1.7–2.3%) increase in ischemic heart disease admissions, respectively. Associations with both PM2.5 and PM10 were stronger in northern China than in southern China in all lag structures. In northern China, an IQR increase in PM2.5 and PM10 concentrations at lag 2 days was associated with a 1.8% (95% CI, 1.6–2.1%) and 2.1% (95% CI, 1.8–2.4%) increase in ischemic heart disease admissions, respectively. In southern China, negative associations were observed with PM2.5 and with PM10 almost at all lag structures. ConclusionShort-term elevations in the levels of PM2.5 and PM10 demonstrate significant associations with an increase in ischemic heart disease. In northern China, the associations between the increase of PM2.5 and PM10 concentrations and IHD admissions were positive. In southern China, the associations were null or negative.

Present and changing trends in surgical modalities and neoadjuvant chemotherapy administration for female breast cancer in Beijing, China: A 10-year (2006-2015) retrospective hospitalization summary report-based study.

BackgroundThis study was conducted to describe present and changing trends in surgical modalities and neoadjuvant chemotherapy (NACT) in female breast cancer patients in China from 2006 to 2015.MethodsData of 44 299 female breast cancer patients from 15 tertiary hospitals in Beijing were extracted from hospitalization summary reports. Surgeries were categorized into five modalities: breast‐conserving surgery (BCS), simple mastectomy (SM), modified radical mastectomy (MRM), radical mastectomy (RM), and extensive radical mastectomy (ERM).ResultsIn total, 38 471 (86.84%) breast cancer patients underwent surgery: 22.64% BCS, 8.22% SM, 63.97% MRM, 4.24% RM, and 0.93% ERM. Older patients (> 60) underwent surgery more frequently than younger patients (< 60). The proportion of patients who underwent BCS was highest in the age ≥ 80 (39.24%) and < 40 (28.69%) subgroups and in patients with papillary carcinoma (35.48%), and lowest in the age 60‐ subgroup (18.17%) and in patients with Paget's disease (19.05%). SM was most frequently performed in patients with Paget's disease (29.00%), and MRM for ductal (64.99%), and lobular (63.78%) carcinomas. During the study period, the proportion of patients who underwent MRM dropped by 29.04%, SM and BCS increased from 15.78% and 30.83%, respectively, and NACT increased in all subgroups, particularly in patients with lymph node involvement (26.72%).ConclusionsSurgical modalities varied significantly by age and histologic group. The use of BCS and SM increased dramatically, while MRM declined significantly. The proportion of patients treated with NACT has increased significantly, especially in patients with lymph node involvement.

Ambient concentrations of particulate matter and hospitalization for depression in 26 Chinese cities: A case-crossover study

ObjectiveAir pollution with high ambient concentrations of particulate matter (PM) has been frequently reported in China. However, no Chinese study has looked into the short-term effect of PM on hospitalization for depression. We used a time-stratified case-crossover design to identify possible links between ambient PM levels and hospital admissions for depression in 26 Chinese cities. MethodsElectronic hospitalization summary reports (January 1, 2014–December 31, 2015) were used to identify hospital admissions related to depression. Conditional logistic regression was applied to determine the association between PM levels and hospitalizations for depression, with stratification by sex, age, and comorbidities. ResultsBoth PM2.5 and PM10 levels were positively associated with the number of hospital admissions for depression. The strongest effect was observed on the day of exposure (lag day 0) for PM10, with an interquartile range increase in PM10 associated with a 3.55% (95% confidence interval: 1.69–5.45) increase in admissions for depression. For PM2.5, the risks of hospitalization peaked on lag day 0 (2.92; 1.37–4.50) and lag day 5 (3.65; 2.09–5.24). The elderly (>65) were more sensitive to PM2.5 exposure (9.23; 5.09–13.53) and PM10 exposure (6.35; 3.31–9.49) on lag day 0, and patients with cardiovascular disease were likely to be hospitalized for depression following exposure to high levels of PM10 (4.47; 2.13–6.85). ConclusionsShort-term elevations in PM may increase the risk of hospitalization for depression, particularly in the elderly and in patients with cardiovascular disease.

Effect of short-term exposure to ambient air particulate matter on incidence of delirium in a surgical population

Delirium remains an independent risk factor for morbidity and mortality among older surgical adults. Recent research has shed light on the relationship between pollution and dementia, yet little is known about the health impacts of particulate matter (PM) on delirium. Therefore, we aim to further explore association of PM and delirium among surgical population. We conducted a time-stratified case-crossover study. Electronic hospitalization summary reports derived from 26 major cities in China between 1 January 2014 and 31 December 2015 were used. Conditional logistic regression were applied to explore the association between perioperative PM exposure and delirium. A total of 559 surgical patients with delirium were identified. Both PM2.5 and SO2 on the day of surgery had a negative impact, with an interquartile range (IQR) increase in PM2.5 (47.5 μg/m3) and SO2 (22.2 μg/m3) significantly associated with an 8.79% (95% confidence interval [CI], 0.01–18.47%, P < 0.05) and 16.83% (95% CI, 0.10–36.35%, P < 0.05) increase in incidence of delirium, respectively. PM on other days during the perioperative period showed no significant impact. The present study showed that short-term exposure to ambient air PM on the day of surgery increased the incidence of delirium in a surgical population during hospitalization.

Fine particulate air pollution and hospital admissions and readmissions for acute myocardial infarction in 26 Chinese cities

Monitoring data on fine particulate matter (PM2.5) level in China's major cities were available since 2013. We conducted a time-stratified case-crossover study to evaluate the association between short-term exposure to PM2.5 and hospital admissions for acute myocardial infarction (AMI), as well as subsequent cardiac and AMI readmissions among AMI survivors. Hospital admissions for ST-elevation myocardial infarction (STEMI) and non ST-elevation myocardial infarction (NSTEMI) from 1 January 2014 through 31 December 2015 were identified from electronic Hospitalization Summary Reports. Conditional logistic regression was used to explore the relation between PM2.5 and hospital admissions for AMI. Individuals discharged alive following STEMI in 2014 were followed up for subsequent readmissions through 31 December 2015. We used the Cox proportional hazards model to evaluate the effect of PM2.5 pollution on subsequent cardiac and STEMI readmissions. Hospital admissions for STEMI (n = 106,467) and NSTEMI (n = 12,719) were examined separately. Exposure to an interquartile range (IQR) increase in PM2.5 concentration (47.5 μg/m3) at lags 2, 3, 4 and 0–5 days corresponded with 0.6% (95% CI, 0.1%–1.1%), 0.8 (95% CI, 0.3%–1.3%), 0.6% (95% CI, 0.1%–1.1%) and 0.9% (95% CI, 0–1.8%) increases in STEMI admissions, respectively. For NSTEMI, no significant association was observed with PM2.5. We also observed significant associations of PM2.5 concentration with both subsequent cardiac and STEMI readmissions among STEMI survivors. In conclusion, short-term elevations in PM2.5 concentration may increase the risk of STEMI but not NSTEMI, and the association appeared to be more evident among STEMI survivors.

CHA2DS2-VASc score as predictor of ischemic stroke in patients undergoing coronary artery bypass grafting and percutaneous coronary intervention

Ischemic stroke following coronary revascularization procedures remains one of the most potentially devastating complications. CHA2DS2-VASc score has been widely used for stroke risk stratification in AF patients. The aim of this nationwide study was to examine the association between the CHA2DS2-VASc score and ischemic stroke following coronary revascularization procedures. We identified patients undergoing coronary revascularization procedures, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), using the electronic Hospitalization Summary Reports. Logistic regression models were applied to evaluate the association of CHA2DS2-VASc score with the risk of post-procedural ischemic stroke. We identified 54,714 patients undergoing CABG and 263,063 patients undergoing PCI from 2013 to 2015. The CHA2DS2-VASc score had a positive graded association with the risk of post-procedural ischemic stroke in both CABG and PCI (P for trend <0.001). The adjusted risk of post-procedural ischemic stroke increased by an estimated 122.4% (odds ratio [OR], 2.22; 95% confidence interval [CI], 2.11–2.35) and 34.7% (OR, 1.35; 95% CI, 1.31–1.39) for each additional 1 point in the CHA2DS2-VASc score in CABG and PCI, respectively. In conclusion, these findings suggested that CHA2DS2-VASc score was an independent predictor of the development of post-procedural ischemic stroke in patients undergoing CABG and PCI.

Ambient Particulate Matter Concentrations and Hospitalization for Stroke in 26 Chinese Cities: A Case-Crossover Study.

Little is known about the short-term health impacts of particulate matter (PM) on stroke in China. We, therefore, conducted a time-stratified case-crossover study to examine the association between ambient PM and hospital admissions for stroke in 26 Chinese cities. We identified hospital admissions for stroke by using electronic hospitalization summary reports from January 1, 2014 through December, 31 2015. We applied conditional logistic regression to explore the association between PM and hospital admissions for stroke. We also assessed the effect modification of stroke risk by geographical region, sex, and age. Hospital admissions for ischemic (n=278 980) and hemorrhagic (69 399) strokes were examined separately. For ischemic stroke, both PM2.5 and PM10 had the strongest effect at lag 3 days, with an interquartile range increase in PM2.5 (47.5 μg/m3) and PM10 (76.9 μg/m3) significantly associated with a 1.0% (95% confidence interval, 0.7%-1.4%) and 0.8% (95% confidence interval, 0.3%-1.3%) increase in admissions for ischemic stroke, respectively. In northern China where PM pollution is more severe, the risk estimates for both PM2.5 and PM10 were larger than those in southern China in all lag structures. An interquartile range increase in PM2.5 and PM10 in northern China corresponded to a 1.0% (95% confidence interval, 0.7%-1.4%) and 0.7% (95% confidence interval, 0.3%-1.2%) increase in ischemic stroke admissions at lag 3 days, respectively. For hemorrhagic stroke, no significant association was observed with PM in the 26 cities. This study suggests that short-term elevations in PM may increase the risk of ischemic but not hemorrhagic stroke. The associations of PM with ischemic stroke are stronger in northern China than in the south.

Air Pollution and Hospitalization for Acute Myocardial Infarction in China

There is growing interest in the association between ambient air pollution and acute myocardial infarction (AMI). The objective of this study was to explore the association in 14 Chinese cities using a time-stratified case-crossover design. We identified 80,787 hospital admissions for AMI between January 1, 2014 and December 31, 2015 from electronic hospitalization summary reports. Conditional logistic regression was used to estimate the percent changes with 95% confidence intervals (CIs) in AMI admissions in relation to an interquartile range increase in ambient air pollutant concentrations. All analyzed air pollutants, with the exception of ozone, were positively associated with daily AMI admissions on lag2 and lag3 days. An interquartile range increase in particulate matter <10 µm in aerodynamic diameter, sulfur dioxide, nitrogen dioxide, and carbon monoxide concentrations on lag2 day was significantly associated with a 0.8% (95% CI 0.1%, 1.6%), 2.0% (95% CI 1.2%, 2.9%), 2.2% (95% CI 1.4%, 3.1%), and 1.1% (95% CI 0.4%, 1.8%) increase in AMI admissions, respectively. We also observed a significant association in relation to ozone on lag4 day (percent change: 1.3%; 95% CI 0.2%, 2.4%). Subgroup analyses indicated no effect modification of risk by age (≥65 years and <65 years) or gender. In conclusion, this is the first multicity study in China, or even in other developing countries, to report the short-term effects of air pollution on AMI morbidity. Our findings contribute to the limited scientific data on the effects of ambient air pollution on AMI in developing countries.

Age-adjusted Charlson comorbidity index score as predictor of survival of patients with digestive system cancer who have undergone surgical resection.

Comorbidities have considerable effects on survival outcomes. The primary objective of this retrospective study was to examine the association between age-adjusted Charlson comorbidity index (ACCI) score and postoperative in-hospital mortality in patients with digestive system cancer who have undergone surgical resection of their cancers. Using electronic hospitalization summary reports, we identified 315,464 patients who had undergone surgery for digestive system cancer in top-rank (Grade 3A) hospitals in China between 2013 and 2015. The Cox proportional hazard regression model was applied to evaluate the effect of ACCI score on postoperative mortality, with adjustments for sex, type of resection, anesthesia methods, and caseload of each healthcare institution. The postoperative in-hospital mortality rate in the study cohort was 1.2% (3,631/315,464). ACCI score had a positive graded association with the risk of postoperative in-hospital mortality for all cancer subtypes. The adjusted HRs for postoperative in-hospital mortality scores ≥ 6 for esophagus, stomach, colorectum, pancreas, and liver and gallbladder cancer were 2.05 (95% CI: 1.45–2.92), 2.00 (95% CI: 1.60–2.49), 2.54 (95% CI: 2.02–3.21), 2.58 (95% CI: 1.68–3.97), and 4.57 (95% CI: 3.37–6.20), respectively, compared to scores of 0–1. These findings suggested that a high ACCI score is an independent predictor of postoperative in-hospital mortality in Chinese patients with digestive system cancer who have undergone surgical resection.

Costs, Trends, and Related Factors in Treating Lung Cancer Patients in 67 Hospitals in Guangxi, China

ABSTRACTLung cancer is a common disease with high mortality in China. Recent economic advances have led to improved medical capabilities, while costs associated with treating this disease have increased. Such change contributes to a commonly held belief that healthcare costs are out of control. However, few studies have examined this issue. Here, we use 34,678 hospitalization summary reports from 67 Guangxi hospitals (period 2013–2016) to document costs, temporal trends, and associated factors. Findings from this study are surprising in that they debunk the myth of uncontrolled healthcare costs. In addition, results and experiences from Guangxi are informative for other comparable regions.